Getting Health Insurance

This blog entry warns you about one of the biggest threats to health in America. It’s not a chemical or a lifestyle. It’s our own health insurance system. I know some readers won’t like this, so I’m telling you my opinion right at the top.

Next to our obsession with drugs, our insurance system is the number one way American medicine hurts people. And which people get hurt the most? According to the American Diabetes Association (ADA) and other experts, it’s usually people with diabetes.

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An “uninsurable condition” According to the ADA, in many states, “state law allows health insurance companies to turn people down for individual health insurance coverage based on the status of their health. In most cases, diabetes is considered an uninsurable condition.” In theory, you cannot be denied insurance through an employer because of diabetes. In practice, some insurers will raise rates so high that employers will not enroll people with diabetes or will not be able to hire them at all.

Because of strong lobbying led by the ADA, the Juvenile Diabetes Research Foundation International (JDRF), and many others, a few states now have laws mandating that people with diabetes be given access to medical insurance. But it can still be extremely difficult to get and extraordinarily expensive.

What’s available (isn’t much) People with diabetes usually face much higher rates when they try to buy insurance. There are some cheaper “bare bones” policies, but they’re not right for people with diabetes, in my opinion. You may be able to get coverage for “catastrophes” such as major hospitalizations. But you probably aren’t covered for physician visits and medicines, much less blood glucose monitoring supplies and education. Without ongoing care, you’re more likely to experience a catastrophe.

If you have a large employer who offers benefits, you might have a better chance. If not, some states have programs for people who can’t get covered in other ways .

A particular issue is coverage for diabetes supplies and self-management training. Advocates for people with diabetes have won laws in 46 states mandating that health insurance cover blood glucose monitoring equipment, education programs, and other needed benefits. Insurers have tried to get these laws overruled at the federal level but have failed so far.

Impact of insurance problems Lack of medical insurance has major effects on people’s lives and health. A recent article on the insurance web site Allied Quotes detailed how amputation rates have risen dramatically among Hispanic people without health insurance. People don’t get timely care, and they develop complications.

Other people have reported losing jobs or even homes to medical costs. Medical expenses contribute hugely to more than half of nearly two million bankruptcies in the U.S. each year. And 75% of these people had insurance at the beginning of their illness. Lack of insurance has also been found to contribute to late cancer diagnosis, increased heart disease, and higher levels of mortality.

Wasteful health insurance overhead is a major reason. Administrative overhead, including marketing and profit margins, added at least $399.4 billion (25% of total expenses) to U.S. medical expenses in 2003, and it’s much higher now.

This is not leftist/Green propaganda (as I have been accused of propagating before). It’s from mainstream medical news publications like Medical News Today, which goes on to report that if we streamlined bureaucracy to Canadian or even to Medicare levels, we would save enough money to fully cover all the uninsured, even without other needed medical system changes. Far from “taking away your choice in medical care,” universal insurance would open choices to millions who have none. I myself have Medicare and find very few restrictions on my care.

Next time, I’ll write about what individuals and families can do about medical insurance problems. It would help if you wrote in with your own experiences dealing with health insurance companies.

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Angela

Perhaps you might mention how long it takes to get an appointment with a doctor in Canada… And also, you might consider where most of the world’s major health innovations come from: the USA. Why? Because of the profit incentive. How many world-renowned medical centers are there in Canada or England? Meanwhile, I’ve personally been treated at two for my diabetes in the US – Darthmouth-Hitchcock and Joslin, and that’s on the east coast alone. I certainly have my own problems with health insurance, and I have no trouble seeing that our system leaves quite a lot to be desired. However, “universal health care” is no solution at all.

CalgaryDiabetic

Dear David. There was an interesting program on PBS comparing health care in the USA, Japan, Taiwan, Germany. If I got this correctly the USA spent the most 22% of GPD on health care compared to Japan at about 12%. Japan has universal coverage. Countries with low health care cost did not even allow GP to act as gate keepers ie you could see a specialist directly. I was wondering if your system has too many mouths to feed: Lawyers, insurance companies, hospital bill collecting staff, doctor’s bill collecting staff, medicare, medicaid and the world’s most highly paid doctors. I know that it is every American’s dream to become a multimillionaire and therefore anything as Communist as universal health care is to be dismissed. The reality is that it is bad enough to have diabetes and trying to do a good job for an employer but the way things are going employers may have to ban diabetics from their work place.

CalgaryDiabetic

Dear Angela. Insulin was a Canadian discovery and islet transplants more recently here in Edmonton and Calgary. Many of worlds large pharmaceutical companies are not American: Glaxo, Sanofi, Aventis, Bayer, Schering. It is true that they use the good old USA as a cash cow, unfortunately they spend most of this windfall on advertising and not research. Many of the Health care problems in Canada have the same origin as in the USA. The most important being that Doctors control the medical schools and strickely limit the number of students. This monopoly violates basic Capitalism and if it was in any other industry the perpetrators would be prosecuted and jailed.

David Spero RN

I appreciate all the comments. But Angela, it’s simply not true that “most of the world’s major health innovations come from the USA.” Maybe it used to be true.

For instance, laparoscopic surgery, perhaps the greatest medical advance of the last 50 years, was developed in Germany. Gastric banding was developed in Sweden and Mexico.

You say universal health care “is not a solution at all.” Well, it wouldn’t solve everything, but for people walking around with diabetic food ulcers or untreated infections or hypertension or 100 other problems because they can’t afford treatment or medication, it would solve a lot.

Without insurance, people (at least non-rich people), wait for things to get critical before they seek help. And especially in diabetes, that often leads to catastrophe. That’s why our current “system” wastes hundreds of billions and gets such terrible results – we have heart-lung transplants on demand for the few, and no basic care for the many.David gastric banding

CalgaryDiabetic

Well it appears that the AMA and Big Pharma suddenly want universal health coverage. You wonder what’s up? Maybe they are terrified of getting a one payer health care system. Which may not be the Capitalist dream of a free market. This you dont have anyways since it is Monopoly versus many un-unified comsumers. With a single payer system you would have Monopoly of provider vs monopoly of payee. This still would make the $2 billion of lobbying very useful. Maybe the solution is to make lobbying a crime.

Calgarydiabetic

Dear Miki you can safely bet your last dollar that George Bush and Steven Harper(Federal Chief of Canada)get better health care than you or I and this regardless of the system. Before the oil boom when we were much poorer we did have very good access to GP, diabetic dietitian, psychologist, and endocrinologist. In essence a team. Now that we have the equivalent of the Klondike Gold Rush and some people and the State Government are getting filthy rich we have very little. Funny how Capitalism works. Super right wing governments do not care about health care. I bet you thought that Canada was commie not in our state. Our state leader is very focused on the needs and wants of big oil even more so than G. Bush that has to cater to a few other interests.

Miki

“If you’re having trouble with blood glucose control in spite of following a balanced diet, speak to your team.”

It is easier to say that then to accomplish.If you have no insurance because of the preexist. cond. you would be lucky to get one doc. attention not to mention a diabetes Team. I encounter this phrase “Diab. Team” so many times in various publications that is unbelievable. You have to be very rich or a member of Congress to have a team to your disposal.

MIKI

Calgarydiabetic,

I understand what you mean. I spent the last 2 years in Germany and had an excellent experience with their gov. run health system. However they do not allow me to stay longer so I came back. This was a kind of thank you – note for rebuiling and defensing Germany after WWII by USA. I have to nevertheless respect their new Eu rules.As we know, nothing is perfect but I wish we can have here a system like that and not to worry of losing everything one works for just because of being uninsurable. I don’t have too much hope for universal health care in US, despite Obama’s or Hillary plans. It will be so many restrictions and exceptions that it will disintegrate. But then, what else?I worked for 25 years for the same health corp. and after my illness – I’m uninsurable.

deb

David, you stated, “Advocates for people with diabetes have won laws in 46 states mandating that health insurance cover blood glucose monitoring equipment, education programs, and other needed benefits. Insurers have tried to get these laws overruled at the federal level but have failed so far.” It is true that my husband insurance will cover glucose equipment and etc,BUT the insurance decide what brand they wish to cover. I had to change my glucose meter from one brand afer using it for years and happy with it to another brand. Due to the insurance would not cover the strips for the old meter. The same goes with doctors where you have to pretty much go with their’s or pay out of your pocket.

Right now I have used half of my medical maximum lifetime benefit on my husband insurance and after that I will have nothing. How can they get a way with that? He is paying high option every month. Hopefully, I will be able to get a career that will not turn me down for insurance due to Diabetic 1, and post- kidney transplant. Is there a way to find out about a companies insurance without jeopardizing your opportunity for that job?

Barry L. Howard

David, I was reading your article and tears well up in my eyes. I am 44 years old male, got laid off and my insurance coverage left to. Only in america people will fight some one else battle and can not take care of their own peoples. I have been trying for the last 2 months to get health insurance and I can’t get coverage. Not in the richest nation in the world, I said. Every insurance company says no too Diabetes. David if you know of somebody that I can get good affordable health insurance with that except type 2 Diabetes please let me know.

David Spero RN

Hi Barry,

I’m sorry you are going through such struggle in our insane “system.” I think if Obama’s plan passes, you will eventually be able to get insurance, but Lord knows what it will cost.

Most states have high-risk pools for people who can’t buy insurance by regular means. Check your state government Web site or information line for something like a Managed Risk Medical Insurance Board or Major Risk Medical Insurance Program (MRMIP.)

And of course, take the best care of yourself that you can. Self-care is probably more important than professional care, and they can’t take that away from you.

David

Robert

Hi Barry,
We need to stop talking about health insurance, and start talking about health care. They are not the same animal. We need to let the healthcare insurance industry die. Government backed health care may not be the most efficient system, but nothing could be worse than allowing profit to dictate health care. Not only do we spend more than any other country on health care, but if you consider how many people aren’t even contributing, the real cost of health care is much higher than the statistics imply. We need to start talking about the cost of not having adequate health instead of worrying about how much it will cost to supply it. Those of us who are lucky enough to have healthcare insurance, should be thinking about how much money is being siphoned off to line the pockets of politicians and investors in an industry that exists only to exploit healthcare, not provide it. Large corporate healthcare plans are simply a way to keep wages low. How many people are working for large companies and stagnant wages just to keep health insurance? A single-payer system would have gone a long way towards putting an end to the obscene profit taking, but our own congress sold us out. Obama caved, and the plan that is left is going to feed the insurance industry. In 2014, we will be able to choose from an open market, but I haven’t seen a single document that details what it will cost for a diabetic to obtain insurance. I assure you, it won’t be cheap, and many will still find themselves out in the cold. This is a travesty.

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